To Understand Health Overhaul, Try A Comic Book

Health care reform is no laughing matter, but MIT economist Jonathan Gruber's new comic book on the subject aims to communicate some pretty complicated policy details in a way that, if not exactly side-splitting, is at least engaging.

In Health Care Reform: What It Is, Why It's Necessary, How It Works, Gruber steps into the pages of a comic book to guide readers through many of the major elements of the law, including the individual mandate to buy insurance, the health insurance exchanges where people will be able to buy coverage starting in 2014 and how the law tackles controlling health care costs.

He ought to know. Gruber helped develop the Massachusetts health overhaul law and advised the Obama administration on the federal version.

Gruber says he was eager to write a book on the federal law because he believes people don't like the concept of the overhaul because they don't understand what's in it. He points to polling that shows the public endorsing individual aspects of the law.

But the decision to do this in a comic-book style was his publisher's. "At first, I wasn't enthusiastic," Gruber says. "I didn't think it would be that effective. But the publisher said they had done a graphic novel about the 9/11 report. My son likes graphic novels, he's 17. He said it's a great opportunity, it's a great medium. When you're on a plane and they want to teach you what to do in case of accident, they hand you a graphic. I think it was the right call."

Although the book is chockablock with optimistic predictions about what will happen under the new law, the chapter on cost control takes a decidedly more cautious tone. Noting that it was politically impossible for the new law to include provisions that could be guaranteed to "bend the cost curve" and control health care costs, Gruber's character says the law took the best ideas out there about what might work and wrote them all into the bill.

He's referring, for example, to provisions under which pricey health insurance plans, often called Cadillac health plans, will begin to be taxed in 2018, and to comparative effectiveness research to evaluate whether expensive health care treatments are actually more effective than cheaper ones.

As the title of his book suggests, Gruber is clearly an advocate for the law. But, he says, "I wanted to be intellectually honest. I believe that cost control is too hard for us to know what to do right now." He cites two hurdles that must be overcome related to cost control: scientific, meaning we don't know what works, and political, meaning we can't always predict what will fly.

"I want to explain to that set of voters and readers who are really critical of this bill because it doesn't do enough on cost contol that that is really an unfair criticism," says Gruber. "We're not really at a place where we could address that problem."